Recent measles (rubeola) outbreak: etiology, symptoms, prevention, treatment, complications, and advice for medical professionals
Authors: Md. Rezaul Islam, Puja Sutro Dhar, Md. Mominur Rahman
Journal: International Journal of Surgery (2023)

Dear Editor, Measles is a severe respiratory viral disease. The prodrome of fever (up to 105°F), malaise, cough, coryza, and conjunctivitis precedes the three ‘C’s, pathognomonic enanthema (Koplik spots), and a maculopapular rash. Typically, the rash appears 14 days following exposure. The rashes extend from the head to the trunk and then down to the lower extremities. Patients are considered contagious for the 4 days prior and 4 days following the rash’s appearance. The rashes may not always appear in immunocompromised people, it should be mentioned1. Between 2 January and 5 March 2022, 3519 probable measles cases were recorded from 19 different regions of the nation; the bulk of these cases were found in districts that had recently suffered drought. The majority of measles cases were reported in six of these 19 regions, including Bay (1195 suspected cases), Mudug (795 suspected cases), Banaadir (558 suspected cases), Bari (278 suspected cases), Lower Shebelle (122 suspected cases), and Gedo (140 suspected cases). A total of 249 samples were gathered and examined at four laboratories around the nation between 2 January and 5 March (in Garowe, Hargeisa, Kismayo, and Mogadishu). A total of 142 of these samples, or 57%, tested positive for measles immunoglobulin M; 81% of the subjects were under the age of 5. In Somalia, where measles is widespread, there are yearly variations in the number of cases. With 23 039 probable cases reported in 118 districts spanning all six federal states and the Banaadir Regional Administration of Somalia, 2017 was the greatest measles outbreak in recent memory. In the midst of the ongoing outbreak in districts hit by the drought, a total of 2596 suspected cases were identified by WHO in 2020, and 7394 suspected cases were identified in 2021. According to WHO-UNICEF national estimates of vaccination coverage, coverage for the first dose of the measles-containing vaccine (MCV1) in Somalia has been estimated to be below average for the past 10 years, at roughly 46%. However, Somaliland has not yet received the second dose of the measles-containing vaccine (MCV2), which was added to the regular immunization regimen in November 20212. While up to one in 100 instances occur in the world’s poorest regions, about one in 5000 cases of measles-related mortality occur in high-income regions of the world, such as Western Europe. Among countries with limited resources, measles continues to be a major cause of mortality, especially in children. In 2016, measles caused 80 000 fatalities. For the first time in records this year, the number of measles deaths globally fell beneath 100 000. But in 2017, there were 100 000 measles deaths worldwide, or more than 400 per day, a rise of more than 20% from the previous year3. The Morbillivirus, an exceedingly contagious virus, is what causes measles. Nine of 10 unvaccinated individuals in a room with a measles carrier would contract the disease. (1) Infected droplets that are released into the air when you cough, sneeze, or talk are one way that measles is spread. (2) Kissing a measles patient. (3) Consuming beverages or food with a measles sufferer. (4) Hugging, shaking hands with, or holding hands with a measles sufferer. (5) From expectant mothers to their unborn children, either during labor or delivery or while breastfeeding. Even after the measles sufferer has left the area, the airborne respiratory droplets may still be there. After being exposed to measles, symptoms might appear anywhere between 6 and 21 days later4. In most cases, symptoms start to show 10–12 days after virus exposure. In some circumstances, the onset of symptoms could be 7 or 21 days in the future. Cough, fever, red watery eyes, runny nose, and are some prior signs. Three to 5 days after the initial symptoms, a rash of red patches appears on the face, which later extend to the rest of the body. Anyone can contract measles, but it affects people more severely who are young, pregnant, or have weakened immune systems5. Measles can also result in catastrophic complications like pneumonia, brain damage, blindness, deafness, and death in certain people, especially those who have ongoing medical conditions, are pregnant, or are undernourished6. You can protect yourself and your family from measles using the safe and dependable MMR vaccine. The MMR vaccine for kids in the USA should be administered twice. Between 1 and 1.5 years is the typical time for the first measles vaccination for infants, followed by another dose between 4 and 6 years. However, the Centers for Disease Control and Prevention (CDC) advises that any infant traveling outside of the USA, even those as young as 6 months old, have a vaccination before leaving the country, followed by two more doses. Teenagers who have only ever had one dose should have the second dose; adolescents who have never received any vaccinations should get two doses at least 27–28 days apart. All adults who were born in 1957 or later and have never had measles should get vaccinated. If you are unsure of your vaccination status, the CDC advises getting another dose of the measles vaccine. Only those with impaired immune systems or women who are pregnant should not receive the measles vaccine. To learn whether you need a vaccination, consult a medical expert7. The greatest way to prevent measles is through vaccination. The measles vaccine offers enduring defense against the disease. Measles vaccination is offered in combination with the mumps, rubella, and varicella vaccines under the names MMR and MMRV, respectively. The live-attenuated (weaken) MMR vaccine results in a mild, noninfectious reaction. The use of MMR is advised by the Advisory Committee on Immunization Practices (ACIP) of the CDC if any of the individual components is necessary. In the USA, there is no single-antigen measles vaccination8. There is no particular treatment for measles. Unlike bacterial infections, viral infections can be treated without the use of antibiotics. The virus and its signs and symptoms usually disappear after 2–3 weeks. There are numerous treatments available for anyone who could have been exposed to the virus. These can lessen the impact of an infection or help avoid it. They consist of: (1) measles vaccination administered 72 hours following exposure, and (2) given a dose of immunoglobulin within 6 days of exposure. To aid in your recovery, your doctor might suggest the following: (A) rest to help strengthen your immune system, (B) lots of fluids, (C) a humidifier to relieve a cough and scratchy throat, (D) vitamin A supplements, (E) acetaminophen (Tylenol) or ibuprofen (Advil) to reduce fever9. There are numerous procedures that can be taken after exposure to the virus to protect those without measles immunity. For instance postexposure immunization: Individuals lacking measles immunity, especially babies, may be immunized within 72 hours of exposure to the measles virus to provide protection against it. In cases where measles does manifest, the illness typically lasts less time and has milder symptoms. Immune serum globulin: The protein immune serum globulin may be administered intravenously to persons with weakened immune systems, children, and pregnant women after exposure to a virus (antibody). These antibodies either stop measles or lessen symptoms when administered within 6 days of virus contact10. Other organs like the brain or lungs could be severely affected if the measles spread there. Measles can cause problems like meningitis, pneumonia, seizures (fits), and blindness. Some people are more vulnerable than others, despite the rarity of these problems. Those covered in this are infants and people with weakened immune systems11. Measles complications could involve things like vomiting and diarrhea: Vomiting and diarrhea may cause the body to lose too much water (dehydration). Ear infection: A bacterial ear infection is one of the most frequent side effects of the measles. Bronchitis, croup, or laryngitis, are all possible side effects of measles that can irritate and inflame the airways. In addition, it could lead to inflammation of the inner walls that encircle the main airways in the lungs (bronchitis). Measles may cause the voice box to become inflamed (laryngitis). Pneumonia: A lung infection brought on by measles is common (pneumonia). A particularly serious form of pneumonia, which can occasionally be fatal, is more likely to affect people with weakened immune systems than healthy individuals. One in 1000 people who have measles may develop the disease encephalitis. The brain is swollen and inflamed during encephalitis. The hazards of the illness may be more dangerous for people whose immune systems are already impaired. Encephalitis can appear immediately or months after measles. Encephalitis may cause a permanent brain injury. Pregnancy issues: If you are expecting, you should take extra precautions to avoid getting the measles because it can result in early birth, low birth weight, and fetal death12. Medical personnel should be on the watch for measles. Verify that all patients have received the MMR vaccine, which guards against measles, mumps, and rubella. Inquire with patients about recent international travel or visits to domestic sites popular with foreign visitors, as well as a history of measles exposures in their communities, and think about measles in patients presenting with febrile rash disease and clinically comparable measles symptoms (cough, coryza, and conjunctivitis). Segregate suspected measles patients as soon as possible, and notify your local health authority of the case to stop the disease’s spread. Obtain samples from probable measles patients for testing, including viral samples for genotyping, which can assist identify the virus’s origin. Consult your neighborhood health agency if you have any inquiries about delivering samples for analysis. Review the Measles Testing Laboratory Guidance for Montana. According to the ACIP, everyone who works in healthcare facilities should have proof of measles immunity. The ACIP’ recommendations are in Immunization of Health-Care Personnel. Measles outbreaks in hospitals can affect patient treatment and increase their risk of developing serious illness. Patients with weaker immune systems and underlying medical problems should pay particular attention to this13. Ethical approval None. Sources of funding None. Authors’ contribution M.R.I.: conceptualization, writing – original draft preparation. P.S.D.: writing and editing. M.M.R.: editing and supervision. All authors have reviewed and approved the final version of the manuscript before submission. Conflicts of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor Md. Mominur Rahman.